Going Abroad to Find Affordable Health Care

Ben Schreiner and his wife, Pamela, traveled to Costa Rica in search of lower cost and better care for Mr. Schreiner's hernia surgery. Credit
Brett Flashnick for The New York Times

WHEN Ben Schreiner, a 62-year-old retired Bank of America executive, found out last year he would need surgery for a double hernia, he started evaluating possible doctors and hospitals. But he didn’t look into the medical center in his hometown, Camden, S.C., or the bigger hospitals in nearby Columbia. Instead, his search led him to consider surgery in such far-flung places as Ireland, Thailand and Turkey.

Ultimately he decided on San José, Costa Rica, where just a week or so after the outpatient procedure and initial recovery, he and his wife were sightseeing throughout the country, then relaxing at a lush resort. He was home four weeks later, with no complications.

Mr. Schreiner is what’s known in the health care world as a “medical tourist.” No longer covered under his former employer’s insurance and too young to qualify for Medicare, Mr. Schreiner has a private health insurance policy with a steep $10,000 deductible. Not wanting to spend all of that on the $14,000 his operation would have cost stateside, he paid only $3,900 in hospital and doctor’s bills in Costa Rica.

“I didn’t have to fork over my entire deductible,” Mr. Schreiner said. “What’s more, they bent over backwards there to take care of me — no waiting, a friendly staff, everyone spoke English.”

At least 85,000 Americans choose to travel abroad for medical procedures each year, according to a recent report by the consulting firm McKinsey & Company. Treatment includes dental implants, hip and knee replacements, heart valve replacements and bypass surgery. The cost of surgery performed overseas can be as little as 20 percent of the price of the same procedure in the United States, according to a recent report by the American Medical Association.

Medical tourism is expected to expand quickly in the coming years because of rising health care costs in the United States, increasing availability of international facilities with United States accreditation, and the fact that insurers and employers are beginning to embrace the practice.

Blue Cross Blue Shield of South Carolina, for example, has started a subsidiary company, Companion Global Healthcare, to offer medical tourism services to individuals and businesses. Hannaford supermarkets in Maine recently added an international option for hip replacements to its health care plan.

At the moment, however, the bulk of medical tourism candidates are uninsured and underinsured people paying their own bills and looking for low-cost alternatives to American care. Medical tourism advocates argue that the quality of care overseas is often equal to or better than that in the United States. Many countries have high success rates, American-trained English-speaking doctors and the newest facilities, often built specifically to attract foreign patients.

But there are no comprehensive data that adequately compare overseas surgical outcomes or other quality measures to those used in the United States, said Dr. Sharon Kleefield of the Harvard Medical School and a specialist in overseas health care quality measures.

“No matter how high your hospital is rated, there are issues with regard to quality and safety when you travel for medical treatment,” she said.

With those cautions in mind, here’s what you need to know if you are considering an international medical option:

Determine whether you are a good candidate. “Traveling for surgery is a big deal,” said Josef Woodman, author of “Patients Beyond Borders: Everybody’s Guide to Affordable World-Class Medical Tourism.” Recovery time is often compressed, and a long flight home can cause complications like a blood clot. You’ll need to provide a thorough health history and have a physical stateside before you go to make sure you can withstand the trip.

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Mr. Woodman points out that not every condition should be treated overseas: “Orthopedic and nonemergency heart procedures have some of the highest success rates. But with something like cancer, you need the ongoing relationship with your oncologist and health care team.”

Get a reliable middleman. Dozens of medical tourism facilitators and planners have sprung up in the past decade hoping to capitalize on the trend and simplify the process for consumers. “Unfortunately, plenty of unreliable firms have sprung up, too,” said Jonathan Edelheit, president of the Medical Tourism Association, a nonprofit organization made up of hospitals and facilitators that cater to traveling patients.

Good firms, said Mr. Edelheit, will match your medical needs with the best overseas hospitals and physicians; make your travel, lodging, visa and local transportation arrangements; handle billing; and help arrange follow-up care. For a list of facilitators vetted by the association, go to medicaltourismassociation.com. Once you narrow your search, ask each potential firm for references and former patients you can interview.

Check out quality yourself. Although medical tourism firms will say they work only with the highest quality hospitals and physicians, you’ll still need to check the records. Don’t be swayed by the luxurious private hospital rooms, gourmet food and other amenities splashed on the Web sites. You want to be sure you’re going to a hospital accredited by the Joint Commission, the organization that reviews both American and international medical and dental facilities, using United State standards. (Find it at www.jointcommissioninternational.org/.)

Be sure to read carefully, a commission spokeswoman, Elizabeth Zhani, warned. You may find a facility’s name on the accreditation list, but it may be that only an affiliated lab or clinic is accredited, not the entire facility.

“Keep in mind that commission accreditation is the floor, not the ceiling,” said Dr. Kleefield. You’ll want to ask your own questions about the facility’s blood safety, medication safety, infection rates and unexpected morbidity rates for the procedure you’re undergoing, and discuss the data with your American doctor.

Just as you would in the United States, you’ll want to interview the physician handling your case before you arrive. Ask if he or she was trained in the United States and is fluent in English, how often he or she has done the procedure you’re having, and what the long-term outcomes have been. Conducting this interview beforehand will also help you establish a rapport with your doctor before you go under the knife.

Arrange your follow-up care in advance. “The biggest stumbling block with medical travel is getting care when you return,” said David Boucher, chief executive of Companion Global. Doctors often balk at treating complications from overseas surgeries because they are unfamiliar with the procedures or prosthetics used or are worried about liability.

Meet with your general practitioner and any specialist who may have been treating you before you go, said Dr. Ted Epperly, the president of the American Academy of Family Physicians: “They’ll be able to provide your medical records, either electronically or on paper, to your overseas doctors.”

Give your doctors in the United States specific details on where you are going for your procedure and contact information for your overseas doctors. And be sure to ask what medical records and information you need to bring home to complete your care.